Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
  • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
  • A61F2/95—Instruments specially adapted for placement or removal of stents or stent-grafts
  • A61F2/962—Instruments specially adapted for placement or removal of stents or stent-grafts having an outer sleeve
  • A61F2/966—Instruments specially adapted for placement or removal of stents or stent-grafts having an outer sleeve with relative longitudinal movement between outer sleeve and prosthesis, e.g. using a push rod
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
  • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
  • A61F2/02—Prostheses implantable into the body
  • A61F2/24—Heart valves ; Vascular valves, e.g. venous valves; Heart implants, e.g. passive devices for improving the function of the native valve or the heart muscle; Transmyocardial revascularisation [TMR] devices; Valves implantable in the body
  • A61F2/2427—Devices for manipulating or deploying heart valves during implantation
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
  • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
  • A61F2/02—Prostheses implantable into the body
  • A61F2/24—Heart valves ; Vascular valves, e.g. venous valves; Heart implants, e.g. passive devices for improving the function of the native valve or the heart muscle; Transmyocardial revascularisation [TMR] devices; Valves implantable in the body
  • A61F2/2427—Devices for manipulating or deploying heart valves during implantation
  • A61F2/2436—Deployment by retracting a sheath
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
  • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
  • A61F2/95—Instruments specially adapted for placement or removal of stents or stent-grafts
  • A61F2/9522—Means for mounting a stent or stent-graft onto or into a placement instrument
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
  • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
  • A61F2/95—Instruments specially adapted for placement or removal of stents or stent-grafts
  • A61F2/962—Instruments specially adapted for placement or removal of stents or stent-grafts having an outer sleeve
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
  • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
  • A61F2/95—Instruments specially adapted for placement or removal of stents or stent-grafts
  • A61F2002/9505—Instruments specially adapted for placement or removal of stents or stent-grafts having retaining means other than an outer sleeve, e.g. male-female connector between stent and instrument
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
  • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
  • A61F2/95—Instruments specially adapted for placement or removal of stents or stent-grafts
  • A61F2/962—Instruments specially adapted for placement or removal of stents or stent-grafts having an outer sleeve
  • A61F2/966—Instruments specially adapted for placement or removal of stents or stent-grafts having an outer sleeve with relative longitudinal movement between outer sleeve and prosthesis, e.g. using a push rod
  • A61F2002/9665—Instruments specially adapted for placement or removal of stents or stent-grafts having an outer sleeve with relative longitudinal movement between outer sleeve and prosthesis, e.g. using a push rod with additional retaining means

Definitions

• Catheter device comprising an implant capsule attached to the outer shaft by means of tabs
• the invention relates to a catheter device according to claim 1.
• Catheter devices of this type are used to transport an implant, for example in the form of a stent or a (for example bioprosthetic) heart valve to a target location in a body lumen of a human or possibly animal patient.
• a catheter device has an inner shaft for supporting said implant, an outer shaft for transporting the implant to the target location, wherein the outer shaft surrounds the inner shaft in cross-section.
• an implant capsule for receiving the implant is provided on the outer shaft, wherein the implant capsule has a tubular capsule core, which surrounds the implant prior to the release. The implant can be moved out from the implant capsule by displacing the inner shaft relative to the outer shaft and can be released and implanted at the target location.
• an outermost stabilisation shaft for stabilising the outer shaft can be provided, wherein the outer shaft is arranged displaceably in a lumen of the stabilisation shaft surrounded by the stabilisation shaft.
• the implant capsule generally has a capsule core, which for example forms a supporting structure of the implant capsule and is to be suitably fixed to the outer shaft.
• connection means in the form of a plastics injection-moulded part is secured to the outer shaft, to which the implant capsule or prosthesis capsule is glued.
• the implant capsule has a metal core and the end thereof has finger-like extensions, which are then encapsulated in a plastics connector.
• the object of the present invention is to further improve a catheter device of the type described in the introduction in respect of the aforementioned problems.
• the subject of claim 1 provides that the capsule core, at one end of the capsule core, has a plurality of tabs for fixing the capsule core to the outer shaft, which tabs protrude from a tubular portion of the capsule core along an axial direction of the capsule core.
• distal means that a corresponding distal component, a distal portion, or a distal end is distanced further from a handle or an operator (doctor) of the catheter device in the axial direction of the outer shaft, along which the longitudinal axis of the outer shaft extends, than a proximal component, a proximal portion, or a proximal end.
• the catheter device can also comprise an inner shaft mounted displaceably in the outer shaft for supporting the implant, wherein the implant can be guided out from the implant capsule by displacing the outer shaft relative to the inner shaft.
• the invention is suitable in particular for a catheter system where the implant is released by a displacement of the outer shaft relative to the inner shaft, in particular where the release is implemented by retracting the outer shaft.
• the capsule core then has, at a proximal end of the capsule core, a plurality of tabs for fixing the capsule core to the outer shaft, wherein the tabs protrude from a tubular portion of the capsule core along an axial direction of the capsule core.
• the implant capsule can also have an outer covering or material layer arranged on the capsule core, which covering or material layer preferably consists of an elastic or viscoelastic polymer.
• covering or material layer preferably consists of an elastic or viscoelastic polymer.
• polymers such as polyurethane or thermoplastic polymers such as thermoplastic copolyamides, for example known under the trade name PEBAX, can be considered as material.
• the implant capsule can comprise an inner covering or material layer surrounded by the capsule core and fixed thereto, which covering or material layer surrounds the actual implant and preferably consists of a plastic having reduced coefficients of friction.
• PTFE also known under the trade name Teflon
• ePTFE or a plastics composite comprising proportions of PTFE or ePTFE is suitable here.
• a monolayer implant capsule which in this case would consist just of the capsule core, which is then referred to as a capsule sleeve.
• a composite material formed of carbon fibres and a plastic is advantageous, wherein the carbon fibres are integrated in the plastic.
• the tabs each have two sides extended along the axial direction, which sides face away from one another in a peripheral direction of the tubular portion, wherein the two sides extend away from one another along the axial direction starting from said tubular portion, such that each tab (starting from said tubular portion) becomes wider accordingly.
• the tabs are therefore also referred to as dovetails.
• the tabs can have small interruptions or indentations, without impairing the function of this embodiment. The widening is decisive for a good transfer of force.
• connection means preferably running around the outer shaft is fixed, in particular welded in place, on a distal end portion of the outer shaft, via which connection means the tabs are connected to the outer shaft, more specifically preferably by screwing the tabs to the connection means Screwing is the preferred and simplest securing method. It also additionally offers the mechanical advantage that the prestress of the tabs can be determined precisely in combination with the connection means. In the case that the connection means are milled out accordingly, the lateral flanks of the tabs can be introduced without play into the milled-out area. The tab is tensioned by means of the screwed connection and the flanks lie without play on the corresponding counterpieces of the recess.
• connection means In principle, however, other methods for securing the tabs, such as gluing or welding, are equally conceivable, but in this case the generation of the prestress and the play-free insertion of the tabs into a possible milled-out area in the connection means is more complex.
• connection means which in the present case is also referred to as a connector, is particularly preferably formed as an annular body, which surrounds the outer shaft in cross- section.
• the connector surrounds the inner shaft in cross-section.
• each tab fixed to the connection means also engages in an associated recess in the connection means, wherein these recesses are formed on a peripheral outer side of the connection means.
• each tab fixed to the connection means preferably engages in an interlocking manner in its associated recess in the connection means.
• said outer side, at a proximal end of the connection means comprises a peripheral conical portion, such that the connection means, at the proximal end of the connection means, has a peripheral chamfer on the outer side, wherein those recesses for receiving the tabs are formed in the conical portion of the outer side.
• each recess has two flanks facing towards one another, which start from a base of the corresponding recess, wherein the recesses taper in the axial direction of the outer shaft towards the tubular portion of the capsule core, such that both flanks extend towards one another accordingly.
• each tab in a state not fixed to the connection means, has a curvature in the peripheral direction of the tubular portion.
• This curvature can correspond to the curvature of the tubular portion in the peripheral direction thereof.
• each tab fixed to the connection means has a smaller curvature in the peripheral direction than in the state not fixed to the connection means, wherein the corresponding tab fixed to the connection means presses with each of its sides against an associated flank of the recess in which the tab is engaged.
• each tab when fixed, in particular screwed in place, in the corresponding recess is pressed flat, thus producing the contact between the outer sides of the corresponding tab and the flanks of the associated recess.
• said smaller curvature does not disappear.
• the tabs are fixed or screwed in place in the recesses such that they are not completely pressed flat, but instead a certain residual curvature remains.
• the tubular portion bears against a peripheral step of the connection means via edge portions extending between adjacent tabs, wherein in accordance with a preferred embodiment of the invention it is provided that said edge portions are drawn against the step by the tabs fixed to the connection means. This can be ensured by the extension of the outer sides of the tabs away from one another and also the corresponding shape of the flanks, whereby the tabs are made to draw the tubular portion of the capsule core fixed thereto against the step during the fixing process
• connection means are curved, starting from the tubular portion, towards the base of their respective associated recesses in the connection means.
• the tabs are fixed to the connection element by means of screws, wherein each screw engages through a through-opening in the corresponding tab and is screwed by means of its external thread to an internal thread of an associated opening in the base of the corresponding recess.
• the capsule core and/or the connection means are/is manufactured from a metal, in particular from a steel.
• a metal in particular from a steel.
• chromium-nickel steel and also cobalt-chromium mixtures or alloys can also be used advantageously as materials in this embodiment of the invention.
• Nickel-titanium alloys (nitinol) or composite materials with carbon fibres are also expedient in specific embodiments.
• the tubular portion of the capsule core has a plurality of parallel slots running along the peripheral direction and also in particular through-openings arranged between adjacent slots.
• the through-openings are formed here automatically as holes created by melting in specific embodiments of the invention where the slots are produced by means of laser cutting in a capsule core made of metal. What are key for this embodiment, however, are the slots running in the peripheral direction.
• the rigidity of the capsule core can be varied by the width and frequency of the slots.
• the rigidity of the capsule core can be varied by the width and frequency of the slots.
• the rigidity of the capsule core is preferably increased gradually towards the transition to the connection means or connector so as to en- sure that the tensile and compressive stresses occurring as a result of bending load are continuously introduced into said connection means or connector.
• Fig. 1 shows a detail of a catheter device according to the invention
• Fig. 2 shows a perspective view of a detail of a capsule core before being fixed to the connection means (connector);
• Fig. 3 shows a further perspective view of a detail of a capsule core before being fixed to the connection means (connector);
• Fig. 4 shows a perspective view of a detail of a capsule core fixed to the connection means
• Fig. 5 shows an illustration of the forces occurring during the fixing process.
• FIG. 1 in conjunction with Figures 2 to 4 shows a catheter device 100 for transporting an implant I (not shown) to a target location of a body lumen of a patient.
• the device 100 here has an elongate inner shaft (not shown) for supporting the implant I, wherein the implant I can be fixed to a distal end of the inner shaft.
• the distal end of the inner shaft is opposite its proximal end, which for example can be fixed to a handle of the catheter device, by means of which the inner shaft and the outer shaft 5 are moved.
• the outer shaft 5 serves here to transport the implant to the selected target location in the body lumen of the patient.
• the outer shaft 5 surrounds the inner shaft, such that this can be guided in the outer shaft 5 and is movable relative to the outer shaft 5 so as to move the implant, for example in the known manner, out from an implant capsule 200 fixed on the outer shaft 5, such that the implant can unfold at the target location or can be unfolded there.
• the outer shaft 5 also has a core made of a cut metal tube (also referred to as a Hypotube), which is sheathed by a polymer (not illustrated).
• the implant capsule 200 has a capsule core 201 made of a metal, for example made of a steel tube, which is cut such that it has, at its proximal end 201a, continuing tabs 203, which for example form a trapezoidal end.
• Each tab 203 or each dovetail 203 thus has outer sides 203a and 203b facing away from one another, which extend away from one another starting from a tubular portion 202 of the capsule core 201.
• the capsule core 201 can also be surrounded outwardly by an outer covering or material layer 207 (also referred to as an outer jacket), wherein an inner covering or material layer 206 can be provided on the inner side of the capsule core and is also referred to as an inner liner.
• the steel tube or the tubular portion 202 has a cut pattern, which for example has parallel slots 204 running in a peripheral direction U and through-openings 205 arranged between the slots 204.
• the cut pattern is formed here such that the rigidity of the capsule core 201 increases gradually at the transition to a connector 300, to which the tabs 203 are fixed.
• the annular connector or connection means 300 preferably manufactured from a metal preferably has an outer side 300a with a conical portion 300c.
• the congruently shaped counter- pieces in the form of the tabs 203, which are disposed on the capsule and are preferably formed integrally with a proximal end 201a of the capsule core 201, are drawn into these pockets 301, in each case by means of a screw 400.
• each screw 400 engages through a through-opening 208 in the associated tab 203 and is screwed into an opening 303 provided on the base 301c of the corresponding recess 301. Since these counterpieces 203 are curved in the peripheral direction U, they are pressed flat when screwed down. As a result, the outer sides 203a, 203b of the tabs are pressed against the accordingly extending flanks or walls 301a, 301b of the recesses 301. Here, a prestressed interlocking connection is pro- Jerusalem, which in particular is free from play.
• the connector 300 additionally has a peripheral step or ring 302, which serves as a stop, wherein the edge portions 201b of the tubular portion 202 of the capsule core 201 extending between the tabs 203 are drawn against said stop.
• connection means/connector 300 The forces occurring as the tabs 203 are fixed at the connection means/connector 300 are indicated in Figure 5.
• the resultant force F res consequently draws the capsule core 201 by means of its edge portions 202b against the step or stop shoulder 302 at the connector 300.
• the capsule core 201 presses thereagainst by the reaction forces F reac t.
• the geometry of the tabs and their respective counterpieces in the connector 300 are selected such that the curve in the assembled state is always retained to a small extent; it can thus be guaranteed that the component parts are braced against one another and that the contact faces thus rest on one another.
• the capsule 200 is connected by means of its load-bearing element, i.e. the capsule core 201 laser-cut from a metal tube for example, to the outer shaft in the above-described way, and thus in an interlocking and play- free manner.
• the distal connector 300 is manufactured from a steel, wherein it is preferably welded onto the outer shaft on the catheter side.
• the high load-bearing capability of the steel at the connector 300 and in the capsule 200 allows a short design, which significantly reduces the rigid proportion of the catheter end. With the play-free connection to the connector 300 and an additional welding of the outer plastic coverings, it is additionally ensured that the tightness in the transition is ensured.
• an O-ring can also be used to produce the tightness (not illustrated).
• a further advantage of this design is that the manufacturing process does not include any injection moulding or gluing. This makes it possible for the capsule 200 to be produced using simple shrinking tubes and hot air fans by means of a melting method, or for the outer jacket 207 to be applied and for the inner liner 206 to be fixed to the core 201 via holes (for example 205) in the capsule core 201, said holes having been produced by melting.

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• 2016
  • 2016-03-30 EP EP16162862.3A patent/EP3225218A1/de not_active Withdrawn
• 2017
  • 2017-03-30 US US16/089,490 patent/US11547586B2/en active Active
  • 2017-03-30 EP EP17713315.4A patent/EP3435932B1/de active Active
  • 2017-03-30 WO PCT/EP2017/057503 patent/WO2017167857A1/en active Application Filing

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